Adolescents and HIV: New WHO recommendations

HIV and adolescents: Guidance for HIV testing and counselling and care for adolescents living with HIV

These WHO recommendations are the first to address the specific needs of adolescents both for those living with HIV as well as those who are at risk of infection. They are being released in advance of World AIDS Day, 1 December 2013.

Why are adolescents important?

More than 2 million adolescents between the ages of 10 and 19 years are living with HIV, and many do not receive the care and support that they need to stay in good health and prevent transmission. In addition, millions more adolescents are at risk of infection.

The failure to support effective and acceptable HIV services for adolescents has resulted in a 50% increase in reported AIDS-related deaths in this group compared with the 30% decline seen in the general population from 2005 to 2012.

“Adolescents face difficult and often confusing emotional and social pressures as they grow from children into adults,” says Dr Gottfried Hirnschall, Director of WHO HIV/AIDS Department. “Adolescents need health services and support, tailored to their needs. They are less likely than adults to be tested for HIV and often need more support than adults to help them maintain care and to stick to treatment.”

"We have seen, for example, in Zimbabwe that by developing adolescent friendly services it is possible to achieve good treatment outcomes among adolescents. We urge others to be inspired by these examples.”

Across sub-Saharan Africa, many who were infected at birth are becoming adolescents. In addition to the many changes associated with adolescence, they also face the challenges of living with a chronic infection, disclosing the news to friends and family and preventing transmission to sexual partners.

Furthermore, many young people do not know their HIV status. For example, in sub-Saharan Africa, it is estimated that only 10% of young men and 15% of young women (15-24 years) know their HIV status and, in other regions, although data is scarce, access to HIV testing and counseling by vulnerable adolescents is consistently reported as being very low.

What does the guidance recommend?

WHO recommends governments review their laws to make it easier for adolescents to obtain HIV testing without needing consent from their parents. The guidelines also suggest ways that health services can improve the quality of care and social support for adolescents. And they highlight the value of involving this age group to create an adolescent-centered approach to the services that work for people of their age.

Key recommendations

HIV testing and counselling, with linkages to prevention, treatment and care, is recommended for adolescents from key populations in all settings (generalized, low and concentrated epidemics).

In generalized epidemics, HIV testing and counselling with linkage to prevention, treatment and care is recommended for all adolescents.

In low and concentrated epidemics, HIV testing and counselling with linkage to prevention, treatment and care is recommended to be made accessible to all adolescents.

Adolescents should be counselled about the potential benefits and risks of disclosure of their HIV status to others and empowered and supported to determine if, when, how and to whom to disclose.

Community-based approaches can improve treatment adherence and retention in care of adolescents living with HIV.

Training of health-care workers can contribute to treatment adherence and improvement in retention in care of adolescents living with HIV.

“Young people need to be better equipped to manage their HIV infection and take ownership of their health care,” says Dr Elizabeth Mason, Director of WHO Maternal, Newborn, Child and Adolescent Health Department. “We have seen for example in Zimbabwe that, by developing adolescent friendly services, it is possible to achieve good treatment outcomes among adolescents. We urge others to be inspired by these examples.”

To help health workers put these recommendations into practice WHO has developed a new online tool which will be launched in January 2014. It uses practical examples from country programmes that are working closely with adolescents on HIV issues.